10 risk factors, warning signs and points to remember about suicidality

Live 10 Risk Factors, Warning

Signs and Points to Remember

About Suicidality

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director AllCEUs.com

Podcast Host: Counselor Toolbox

AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $4

Objectives

Identify general practice points

Explore/review risk and protective factors

Identify suicide warning signs IS PATH WARMED

Learn the SPLASH acronym for suicide screening


General Practice Points

1. Clients should be screened for suicidal thoughts and behaviors routinely at intake and at specific points in the course of treatment

2. Screening for clients with high risk factors should occur regularly throughout treatment. (preferably at each episode)

3. Counselors should be prepared to develop and implement a treatment plan to address suicidality and coordinate the plan with other providers.

4. If a referral is made, counselors should check that referral appointments are kept and continue to monitor clients after crises have passed, through ongoing coordination with mental health providers and other practitioners, family members, and community resources, as appropriate.


General cont…

5. Counselors should acquire basic knowledge about the role of warning signs, risk factors, and protective factors as they relate to suicide risk.

6. Counselors should be empathic and nonjudgmental with people who experience suicidal thoughts and behaviors.

7. Counselors should understand the impact of their own attitudes and experiences with suicidality on their counseling work with clients.

8. Counselors should understand the ethical and legal principles and potential areas of conflict that exist in working with clients who have suicidal thoughts and behaviors.


General cont.

9. Suicide risk may increase at transition points in care),

especially when a planned transition breaks down. Anticipating

risk at such transition points should be regarded as an issue in

treatment planning.

10. Suicide risk may increase when a client is terminated

administratively (e.g., because of poor attendance, chronic

substance use) or is refused care.

It is unethical to discharge a client and/or refuse care to someone

who is suicidal without making appropriate alternative

arrangements for treatment to address suicide risk.

11. Suicide risk may increase in clients with a history of suicidal

thoughts or attempts who relapse. Treatment plans for such

clients should provide for this possibility.


General cont.

12. Suicide risk may increase in clients with a history of

suicidal thoughts or attempts who imply that the worst

might happen if they relapse (e.g., “I can't go through

this again,” “if I relapse, that's it”)—especially for those

who make a direct threat (e.g., “This is my last chance;

if I relapse, I'm going to kill myself”).

13. Suicide risk may increase when clients are experiencing

acute stressful life events. Treatment should be adjusted

by adding more intensive treatment, closer observation,

or additional services to manage the life crises.


10 Risk Factors

1. Mental health conditions

Depression

Substance use problems

Bipolar disorder

Schizophrenia

Emotional dysregulation

Conduct disorder

Anxiety disorders

2. Serious or chronic health conditions and/or pain

3. Traumatic brain injury


10 Risk Factors

4. Precipitants/triggering events leading to humiliation,

shame, or despair (e.g., loss of relationship, health or

financial status – real or anticipated

Prolonged stress, such as harassment, bullying, relationship

problems or unemployment

Stressful life events, which may include a death, divorce or

job loss

5. Exposure to another person’s suicide, or to graphic or

sensationalized accounts of suicide including through

media

6. Family violence or physical or sexual abuse

7. Previous suicide attempts


10 Risk Factors

4. Family history of suicide

5. Barriers to accessing health care, especially mental

health and substance abuse treatment

6. Certain cultural and religious beliefs (for instance, the

belief that suicide is a noble resolution of a personal

dilemma)


Warning Signs IS PATH WARMED1. I – Ideation (suicidal thoughts)

2. S – Substance Abuse

3. P – Purposelessness/No Reason to Live

4. A – Anxiety

5. T – Trapped

6. H – Hopelessness/Helplessness/Being a Burden

7. W – Withdrawal/Isolation

8. A – Anger, Aggression, Agitation

9. R – Recklessness

10. M – Mood changes

Esp. Sudden, unexpected switch from being very sad to being very calm or appearing to be happy

11. E– Extreme pain

12. D- Depression


Additional Warning Signs Significant sleep changes

Direct and indirect verbal expressions: “I don’t want to live anymore”, “there is nothing to live for anymore”, “people will be better off without me”

Risk taking behavior

Lack of self care or outright neglect of self

Changes in eating and sleeping pattern

Giving away prize possessions and/or making a will; tidying up personal affairs; writing notes; making notes on belongings

Reconnecting with old friends and extended family as if to say goodbye

Unwillingness to discuss future plans

https://afsp.org/about-

suicide/risk-factors-and-

warning-signs/AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $4

Protective Factors

Sense of responsibility to family

Life satisfaction

Social support; belongingness

Coping skills

Problem-solving skills

Reality testing ability

Religious faith

Reasons for living


Protective Factors

Family

Presence of a child in the home and/or childrearing responsibilities

Intact marriage

Beloved pets

Personal

Trait optimism (a tendency to look at the positive side of life)

Adaptive coping skills

Effective problem-solving skills

Self-understanding

Sense of competence

Spirituality

Being clean and sober


Protective Factors

Employment

Positive relationships with colleagues

Professional development opportunities

Access to employee assistance programs

Community

Involvement and opportunities to participate in the

community

Trusting relationship with a counselor, physician, or other

service provider

Affordable, accessible supportive services


Assessment: SPLASH

Suicidal thoughts

Are suicidal thoughts present?

When did these thoughts begin?

How persistent are they?

Can they control them?

What has stopped the person acting on their thoughts so far?

Has the person made any plans?

How specific is it?

Is there a specific method and place?

How often does the person think about the plan?


Assessment: SPLASH

Protective Factors

Lethality

Access/availability of proposed method

Seclusion—How long would it take for resources to get

there

History of suicidal behavior

Has the person felt like this before?

Has the person harmed themselves before?

What were the details and circumstances of the previous

attempts?

Are there similarities in the current circumstances?


10 Points to Remember1. Almost all of your clients who are suicidal are ambivalent

about living or not living.

2. Suicidal crises can be overcome.

3. Although suicide cannot be predicted with certainty, suicide risk assessment is a valuable clinical tool.

4. Suicide prevention actions should extend beyond the immediate crisis.

5. Suicide contracts are not recommended and are never sufficient

6. Some clients will be at risk of suicide, even recovering from their presenting issue(s)

7. Suicide attempts always must be taken seriously.


10 Points to Remember

8. Suicidal individuals generally show warning signs.

9. It is best to ask clients about suicide, and ask directly.

10. The outcome does not tell the whole story.

a good outcome (survival) does not, by itself, equate to

proper treatment of suicidal thoughts and behaviors


Personal Attitude Survey What is my personal and family history with suicidal thoughts

and behaviors?

What personal experiences do I have with suicide or suicide attempts, and how do they affect my work with suicidal clients?

What is my emotional reaction to clients who are suicidal?

How do I feel when talking to clients about their suicidal thoughts and behaviors?

What did I learn about suicide in my formative years?

How does what I learned then affect how I relate today to people who are suicidal, and how do I feel about clients who are suicidal?

What beliefs and attitudes do I hold today that might limit me in working with people who are suicidal?


Points to Remember

People in treatment settings may need additional services to

ensure their safety.

All clients should be screened for suicidal thoughts and

behaviors as a matter of routine.

Screen for suicide and ask followup questions.

Follow up with a client when risk has been previously documented.

Take appropriate action when risk is detected.

Document suicide-related screening and interventions.

Communicate suicide risk to another professional or agency.

All expressions of suicidality indicate significant distress and

heightened vulnerability that require further questioning and

action.


Points

Warning signs for suicide can be indirect; you need to

develop a heightened sensitivity expressions of

hopelessness, feeling trapped, or having no purpose in life,

and observable signs such as withdrawal from others,

mood changes, or reckless behavior.

Talking about a client's past suicidal behavior can provide

information about triggers for suicidal behavior.

Give clients who are at risk of suicide the telephone

number of a suicide hotline; it does no harm and could

actually save a life.


Summary

Suicidal ideation represents an opportunity

Clinicians need to prepare ahead of time for the event of a

suicidal client

Suicide assessment should be part of every assessment,

and ideally a mini-assessment completed at each visit

Be aware of and educate clients and their families about

suicide risk factors and warning signs and steps to take in

the event of a crisis

Always document assessments and interventions (checklists

are good for this)


Resources

NIMH Publications in English and Spanish

SAMHSA Addressing Suicidal Thoughts and Behaviors in

Substance Abuse Treatment.

Suicide publications for clients by SAMHSA


https://www.nimh.nih.gov/health/publications/suicide-prevention-listing.shtml

https://store.samhsa.gov/product/TIP-50-Addressing-Suicidal-Thoughts-and-Behaviors-in-Substance-Abuse-Treatment/SMA15-4381

https://store.samhsa.gov/facet/Issues-Conditions-Disorders/term/Suicide?pageNumber=1

10 risk factors, warning signs and points to remember about suicidality

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